MEDICARE: MR. IRA HAUER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	029194	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	029194	OTHER	NY	NY STATE PHARMACY LICENSE

General Provider Information

NPI Number	:	1003084963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRA HAUER

Provider Business Mailing Address
First Line	:	800 MONTAUK HWY
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-2128
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 MONTAUK HWY
Second Line	:
City	:	SHIRLEY
State	:	NY
Zip	:	11967-2128
Country	:	US
Telephone Number	:	631-399-5252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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Directions to “ MR. IRA HAUER ” Practice Location

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